Provider Demographics
NPI:1093839581
Name:RHODES, RANDOLPH (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1633
Mailing Address - Country:US
Mailing Address - Phone:650-369-4595
Mailing Address - Fax:650-369-3184
Practice Address - Street 1:650 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1300
Practice Address - Country:US
Practice Address - Phone:650-369-4595
Practice Address - Fax:650-369-3184
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 16496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor